Explanatory Models and Mental Health Treatment: Is Vodou an Obstacle to Psychiatric Treatment in Rural Haiti?

Emory University School of Medicine, Atlanta, GA, USA.
Culture Medicine and Psychiatry (Impact Factor: 1.29). 04/2012; 36(3):514-34. DOI: 10.1007/s11013-012-9270-2
Source: PubMed


Vodou as an explanatory framework for illness has been considered an impediment to biomedical psychiatric treatment in rural Haiti by some scholars and Haitian professionals. According to this perspective, attribution of mental illness to supernatural possession drives individuals to seek care from houngan-s (Vodou priests) and other folk practitioners, rather than physicians, psychologists, or psychiatrists. This study investigates whether explanatory models of mental illness invoking supernatural causation result in care-seeking from folk practitioners and resistance to biomedical treatment. The study comprised 31 semi-structured interviews with community leaders, traditional healers, religious leaders, and biomedical providers, 10 focus group discussions with community members, community health workers, health promoters, community leaders, and church members; and four in-depth case studies of individuals exhibiting mental illness symptoms conducted in Haiti's Central Plateau. Respondents invoked multiple explanatory models for mental illness and expressed willingness to receive treatment from both traditional and biomedical practitioners. Folk practitioners expressed a desire to collaborate with biomedical providers and often referred patients to hospitals. At the same time, respondents perceived the biomedical system as largely ineffective for treating mental health problems. Explanatory models rooted in Vodou ethnopsychology were not primary barriers to pursuing psychiatric treatment. Rather, structural factors including scarcity of treatment resources and lack of psychiatric training among health practitioners created the greatest impediments to biomedical care for mental health concerns in rural Haiti.

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    • "Hollan and Wellenkamp, 1994 Laos Khut L ai Thinking too much Westermeyer, 1979 Malaysia Banyak fikir Thinking too much Abdul Kadir and Bifulco, 2010 Thailand Kaankhitmaak Thinking a lot Muecke, 1994 AUSTRALIA/PACIFIC ISLANDS Australia Kuliniekulini Too much thinking Brown et al., 2012 Papua New Guinea Tingting planti Thinking too much Hinton and Earnest, 2010 Timor-Leste Hanoin barak Thinking too much Le Touze et al., 2005; Sakti, 2013 CENTRAL/SOUTH AMERICA AND CARIBBEAN Haiti Kalkile tw op Thinking too much Rasmussen et al., 2015 Haiti Maladi kalkilasyon Thinking too much (literally " thinking/calculating sickness " ) McLean et al., 2015 Haiti Panse anpil Thinking too much Bolton et al., 2012 Haiti Reflechi tw op Thinking too much Kaiser et al., 2013; Kaiser et al., 2015; Kaiser et al., 2014; Keys et al., 2012; Khoury et al., 2012 Nicaragua Pensando mucho Thinking too much Yarris, 2011a; 2011b; 2014 "
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    ABSTRACT: Idioms of distress communicate suffering via reference to shared ethnopsychologies, and better understanding of idioms of distress can contribute to effective clinical and public health communication. This systematic review is a qualitative synthesis of "thinking too much" idioms globally, to determine their applicability and variability across cultures. We searched eight databases and retained publications if they included empirical quantitative, qualitative, or mixed-methods research regarding a "thinking too much" idiom and were in English. In total, 138 publications from 1979 to 2014 met inclusion criteria. We examined the descriptive epidemiology, phenomenology, etiology, and course of "thinking too much" idioms and compared them to psychiatric constructs. "Thinking too much" idioms typically reference ruminative, intrusive, and anxious thoughts and result in a range of perceived complications, physical and mental illnesses, or even death. These idioms appear to have variable overlap with common psychiatric constructs, including depression, anxiety, and PTSD. However, "thinking too much" idioms reflect aspects of experience, distress, and social positioning not captured by psychiatric diagnoses and often show wide within-cultural variation, in addition to between-cultural differences. Taken together, these findings suggest that "thinking too much" should not be interpreted as a gloss for psychiatric disorder nor assumed to be a unitary symptom or syndrome within a culture. We suggest five key ways in which engagement with "thinking too much" idioms can improve global mental health research and interventions: it (1) incorporates a key idiom of distress into measurement and screening to improve validity of efforts at identifying those in need of services and tracking treatment outcomes; (2) facilitates exploration of ethnopsychology in order to bolster cultural appropriateness of interventions; (3) strengthens public health communication to encourage engagement in treatment; (4) reduces stigma by enhancing understanding, promoting treatment-seeking, and avoiding unintentionally contributing to stigmatization; and (5) identifies a key locally salient treatment target.
    Full-text · Article · Oct 2015 · Social Science [?] Medicine
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    • "Additionally, strengthening existing forms of community support in migrant communities and following principles of the apprenticeship model to train CHWs and lay providers can help reduce harmful effects of discrimination and stigma (Murray et al. 2011). Based on findings in Haiti (Wagenaar et al. 2013; Khoury et al. 2012), community-based support in Haitian migrant communities likely includes nonbiomedical care providers, such as Christian pastors and traditional healers, including Vodou priests and herbalists. Support networks in migrant communities are underexplored and deserve more inquiry. "
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    ABSTRACT: Objective: Many Haitian migrants live and work as undocumented laborers in the Dominican Republic. This study examines the legacy of anti-Haitian discrimination in the Dominican Republic and association of discrimination with mental health among Haitian migrants. Design: This study used mixed methods to generate hypotheses for associations between discrimination and mental health of Haitian migrants in the Dominican Republic. In-depth interviews were conducted with 21 Haitian and 18 Dominican community members and clinicians. One hundred and twenty-seven Haitian migrants participated in a pilot cross-sectional community survey. Instruments included culturally adapted Kreyòl versions of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) and a locally developed function impairment scale. Results: Haitian migrants described humiliation (imilyasyon) as a reason for mental distress and barrier to health care. Dominicans reported that discrimination (discriminación) was not a current social problem and attributed negative social interactions to sociocultural, behavioral, and biological differences between Dominicans and Haitians. These qualitative findings were supported in the quantitative analyses. Perceived discrimination was significantly associated with depression severity and functional impairment. Perceived mistreatment by Dominicans was associated with a 6.6-point increase in BDI score (90% confidence interval [CI]: 3.29, 9.9). Knowing someone who was interrogated or deported was associated with a 3.4-point increase in BAI score (90% CI: 0.22, 6.64). Conclusion: Both qualitative and quantitative methods suggest that perceived discrimination and the experience of humiliation contribute to Haitian migrant mental ill-health and limit access to health care. Future research should evaluate these associations and identify intervention pathways for both improved treatment access and reduction of discrimination-related health risk factors.
    Full-text · Article · Apr 2014 · Ethnicity and Health
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    • "According to locally preferred terminology (Kaiser et al., in press), suicide was described as mwen ta touye tèt mwen (to kill myself) and ideation as panse sou touye tèt (thinking about killing oneself). See Kaiser et al. (in press), Keys et al. (2012), and Khoury et al. (2012) for additional information on participant observation, qualitative interviews, and Kreyòl terminology. "
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    ABSTRACT: Suicide is a complex global public health problem, yet few studies have examined local socio-cultural explanatory models and other contextual factors surrounding suicide in low-and-middle-income countries. Such research is critical, as suicide frequency and etiology, as well as care-seeking in the case of distress, differ contextually and by sub-groups within a population. This is the first study of its kind to explore the dual perspectives of both healthcare workers and community members regarding suicide in Haiti. We conducted semi-structured, in-depth interviews between May and June 2011 with eight biomedical healthcare workers and 16 lay community members. Qualitative data analysis, drawing on interpretive phenomenological analysis, addressed themes including perceived suicide frequency, veracity of suicidal ideation claims, perceived causal factors, religious constructs related to suicide, and support resources for suicidality. Compared to community members, healthcare workers underestimated the frequency of suicide and were less likely to interpret suicide-related claims as representing true intent. Religious perspectives influenced attitudes toward suicide, albeit in different ways: Christian concern with the afterlife resulted in suicide being unacceptable and sinful, while Vodou explanatory frameworks displaced blame and stigma away from suicidal individuals. Healthcare workers' failure to recognize suicide as a serious problem suggests that the formal health system is currently ill-equipped to respond to suicide-related needs. Religious practice and community supports in rural Haiti may serve as essential resources for prevention programs.
    Full-text · Article · Apr 2013 · Social Science [?] Medicine
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